Multiple Births via IVF and the Octuplet Mess that is Increasing Scrutiny of the Industry

The octuplet "mess" will just not want to go away, especially now with a sperm donor claiming to be involved in the mix as shown on Good Morning America.

However, there were several articles over the last few days that I think will help everyone take a look at the real costs of multiples births, as well as how this one case may end up forcing the industry to take a good look at itself. 

The first one is through the New York Times, and it takes a hard look at the fertility industry.  They think that the octuplets' birth is a real wake up call:

"The American Society for Reproductive Medicine, the association of fertility doctors, even adopted guidelines in 2008 encouraging the transfer of only one embryo for women under 35, and no more than two, except in extraordinary circumstances. The guidelines allow more for older women, up to a maximum of five.

But unlike some other countries, the United States has no laws to enforce those guidelines. The Centers for Disease Control and Prevention has a surveillance system that collects data on fertility clinics, but reporting is voluntary and there are no government sanctions for not reporting.

As a result, experts say many doctors are still implanting too many embryos to increase the chance of pregnancy. Only 11 percent of in vitro procedures in the United States involve single embryos, according to 2006 data from the C.D.C."

Click Here for the Complete Article

Furthermore, in Newsweek, an article by Dr. Mark Evans talks about the other side of multiple births - selective reduction.  He states the following:

"When I first heard that a California woman had given birth to octuplets after undergoing in vitro fertilization, I couldn't believe it. As the details of Nadia Suleman's story emerged, it became only more incredible. As it turned out, a clinic transferred six embryos (two of which later split into identical twins) to Suleman, who had six children already, meaning she was extremely fertile. I have nothing against IVF. More than 2 million women worldwide have children because of it. But with the increase in fertility treatments, the U.S. birthrate of twins has more than doubled in the past 30 years. Overlooked in the happy news, though, are the troubling surges in neonatal deaths, developmental disabilities and other long-term problems.

For those reasons, doctors prefer to avoid multiple births. But with each cycle of IVF costing more than $10,000, there's enormous pressure to get patients pregnant—fast. Guidelines of the American Society of Reproductive Medicine and the Society of Assisted Reproductive Technologies say that in women under 35, usually only one or two embryos should be transferred to the uterus in any cycle. The U.S. average is 2.4. A third of such pregnancies result in twins, and 4.3 percent yield triplets or more. In women over 35, the overall pregnancy rate falls dramatically, and the proportion of multiples goes up."

He goes on to talk about the criticism that he receives regarding selective reduction as a solution in some cases:

"Of course, selective reduction can be an agonizing decision for a parent, but most of the couples who come to me have had a longstanding infertility problem. For them, selective reduction is just one more hurdle to deal with. But they are better able to cope when they know the facts: a woman with a quadruple pregnancy has about a 25 percent chance of losing all four babies, but she can decrease the loss rate to about 5 percent by reducing to twins. The risks of prematurity, cerebral palsy and genetic abnormalities (if tested) are all reduced, too.

Reduction will always be controversial. A woman has an abortion because she wants—for whatever reason—to not have a child. But women who have reductions are often desperate to have children. In high-risk situations, reduction may be the best way—sometimes the only way—for that to happen. I realize that in the minds of pro-lifers, this reasoning is flawed. But if performing this procedure means that couples who have suffered years of anguish can have their own healthy children, I'll take all the criticism I get."

Click Here for Complete Article
 

Theresa M. Erickson, Esq.
Surrogacy Lawyer & Egg Donation Lawyer 
www.EricksonLaw.net

Subscribe to my blog at: http://www.surrogacyeggdonorblog.com/subscribe.html

FRIDAY LEGAL UPATES - Wisconsin Adoption, Georgia Right to Life Group, Missouri Donor Legislation, North Dakota Egg Legislation, Hawaii Civil Union, Indian Surrogacy Update, Australian Twins & ESHRE

Well, welcome to our Friday Legal Updates (TGIF).  We have quite a bit of news out there from this week, so enjoy each one, and please comment to your heart’s desire.

Wisconsin – Woman Charged with Unauthorized Adoption.  A Missouri woman faces a felony child abduction charge in Wisconsin where she's accused of buying a baby from a couple for $6,000.   There was a criminal complaint filed Thursday stating that 36-year-old Denise Novotny of Clinton, MO, received the infant shortly after she was born at Aurora Medical Center in Hartford in December 2004.  The complaint also alleges that Novotny had the couple sign a surrogate birth contract to disguise the crime.   This sounds like adoptions being disguised as a surrogacy is a trend for circumventing the laws of adoption.  We need to be wary of this and be on alert for this situation in our own practices.

Click Here for Complete Article

Georgia – The Georgia Right to Life Introduces Legislation to Protect the Mother and Child.  Georgia Right to Life today announced the filing of the Ethical Treatment of Human Embryos act in the Georgia Senate SB-169.  Their argument is that the recent birth of the octuplets to the woman in Southern California demands government oversight of the fertility industry, according to this group. 

“This industry is one of the most lucrative medical fields and among the least regulated. In response to this need, Georgia State Senator Ralph Hudgens along with other co-sponsors in the Senate leadership have introduced legislation that will place limits on the creation and transfer of embryos produced by In vitro fertilization (IVF).

‘This bill is written to help reduce the attendant harm that could come to the mother and her children through the creation and implantation of more embryos than is medically recommended by industry watchdog groups like the Society for Assisted Reproductive Technology’ says Daniel Becker, President of Georgia Right to Life.

‘This bill would limit the number of embryos transferred in any given cycle to the same number that are fertilized, up to a maximum of three. This bill is similar to the same common-sense regulations passed in other countries such as the United Kingdom, Germany and Italy’ said Becker.

Georgia is the first state in the nation to file this legislation. However, in Britain they have similar legislation, passed in 2004, that protects the embryo and the mother from these harmful practices.

Click Here for Complete Article

The language of the bill-SB 169

North Dakota – North Dakota House Gives Fertilized Egg Full Rights. News just out of North Dakota - we have a bill pending that intends to give a fertilized human egg the legal rights of a human being.  It appears that the intention is to put a complete ban on abortion in that state.  However, based on the field that I am in, I am concerned what it will do to the infertile couple/person with embryos frozen in that state.  What are your thoughts after reading below?

“BISMARCK, N.D. — A measure approved by the North Dakota House gives a fertilized human egg the legal rights of a human being, a step that would essentially ban abortion in the state.

The bill is a direct challenge to Roe v. Wade, the U.S. Supreme Court decision that extended abortion rights nationwide, supporters of the legislation said.

Representatives voted 51-41 to approve the measure Tuesday. It now moves to the North Dakota Senate for its review.

The bill declares that “any organism with the genome of homo sapiens” is a person protected by rights granted by the North Dakota Constitution and state laws.

The measure’s sponsor, Rep. Dan Ruby, R-Minot, said the legislation did not automatically ban abortion. Ruby has introduced bills in previous sessions of the Legislature to prohibit abortion in North Dakota.

“This language is not as aggressive as the direct ban legislation that I’ve proposed in the past,” Ruby said during House floor debate on Tuesday. “This is very simply defining when life begins, and giving that life some protections under our Constitution - the right to life, liberty and the pursuit of happiness.”

Critics of the measure say it will cost millions of dollars to defend. Ruby said the state has been willing to go to bat for other principles that were less important.

In Oklahoma, meanwhile, a state House committee Tuesday approved legislation that would prohibit physicians from performing abortions solely on account of the gender of a woman’s fetus, even though the measure’s author said there is no evidence the practice has ever occurred in the state.

The legislation passed 20-2 by the House Public Health Committee. The bill now goes to the full House for consideration.

The author of the bill, Rep. Dan Sullivan, R-Tulsa, said it is designed to stop couples from using the gender of a fetus as a reason to get an abortion. Sullivan said a doctor would be prohibited from performing an abortion if the mother specifically said the fetus’ sex was the reason.

However, he said there is no evidence the practice has occurred in Oklahoma. “I haven’t received any definite information that proves it,” Sullivan said.”

Click Here for Complete Article

Missouri – Sounds to me like the states are responding in great numbers to the advancements in reproductive technologies and now the octuplet controversy, which I vow not to address in today’s updates.  However, I did post this last week, but I am reposting again in light of the other states to follow.

It appears that the Missouri legislature, headed by Cynthia Davis.  In her bill (HB355) she is attempting to ban all anonymous donation (egg and sperm) in Missouri and give all donor-conceived offspring the right to access the donor’s identity at age 21.   In fact, she wants the child’s birth certificate reflect the biological parent’s name (yes, she called the donor a parent) and the donor parent’s name as well.  She is not intending to create any legal relationship between donors and the offspring, but the use of the word PARENT is extremely disturbing.  What do you think?

Click Here for the information on this bill HB355

Blog On Bill HB355 

Hawaii – Civil Unions in Hawaii.  Hawaii’s House passed a civil union bill this month by a vote of 33-15. 

"The bill, which now moves to the state Senate, would grant partners in civil unions the same benefits, protections and responsibilities as married couples under state law. The state would also recognize civil unions, domestic partnerships and same-sex marriages performed in other states. Partners in civil unions would not have the same protections as married couples under federal law, so the recognition is a rung below treating homosexual and heterosexual couples equally."

According to the Honolulu Advertiser, "The lawmaker who missed the vote, state Rep. K. Mark Takai, D-34th (Newtown, Waiau, Pearl City), who is preparing to deploy with the Hawai'i Army National Guard to Kuwait, supports civil unions."

Click Here for Complete Article

Other Article on www.Proudparenting.com

Australia – Lesbians Win Damages for Second Child – yes, you heard it right.  A lesbian couple have won the right to be compensated by their IVF Physician for the wrongful birth of one of their twins.  The woman gave birth to healthy non-identical twin girls in July of 2004, and the couple had sought $348,000.00 in damages for the cost of raising one of the girls.  The court papers state that the woman had told the doctor to implant only one embryo; however, two embryos were implanted.  Their intital case had been rejected by the courts, but was overturned on appeal with the court granting damages of $317,000.00 plus fees, which includes fees for a private Steiner school.

Click Here for Complete Article

India – Surrogacy is No Business, It’s a Need: Experts.  With reproductive tourism exploding, I like to keep people alert to the dangers of going to countries where the laws are not yet in place.  If you think California is the wild west, think again, as that is not the case.  But, if you are going to India, buyer beware!

"Surrogacy is not a business, it arises out of need. It gives women an opportunity to make a bright future for themselves and for others," R S Sharma, deputy director, Indian Council Medical Research (ICMR) said at a seminar held at the ILS Law College on Wednesday.

The ILS Law college conducted this seminar chiefly to identify the loopholes in the proposed Assisted Reproductive Technology (ART) (regulation) Bill and suggest changes.

Sharma presented the draft bill on the issue title Assisted Reproductive Technology (regulation) Bill, 2008'. In India, there is no law to regulate surrogacy and the government now wants to fill this void to avoid exploitation of the parties involved. Following this, a 15-member committee, including experts from ICMR, Ministry of Health and specialists in the field, prepared this bill and will table it before the Lok Sabha in the ensuing session.

"It is incorrect to label surrogacy as a business. Both parties involved are benefited and is undertaken only after they arrive at a mutual consensus. Take for instance this case where the wife decided to become a surrogate because she needed money for her husband's treatment. Also, the family was so financially weak that they were not being able to make their ends meet. After opting for surrogacy, she was not only able to get her husband treated, but also spent on her children's education. Would you call this a business?" Sharma questioned the audience.

As a result of the increasing demand for various types of ARTs, infertility clinics too have mushroomed indiscriminately across the nation. In the absence of national registry of ART clinics, there is no reliable information available on their number.

Sanjay Gupte, director, Centre for Research in Reproduction, who was also present at the seminar, said, "It is often said that doctors make good profit from surrogacy in India. However, very few talk of the drug companies that sell infertility drugs and make money. They (the companies) are, in fact, the ones who are promoting malpractices in the system. We need strict laws to bind such companies, this in turn will help control the number of ART clinics."

Sunita Tadulwalkar, in-charge of the IVF Clinic at Ruby Hall, said, "This was the most awaited bill as the number of ART clinics has increased significantly over the past five years. The bill will definitely improve the quality of treatment. However, I also see that the bill does not mention insurance. There is a lot of risk involved in this process and insurance companies flatly refuse to pay for infertility treatments."

Students of the ILS Law College identified loopholes in the bill, particularly with respect to the status and rights of children born out of such process.

 

Click Here for Complete Article

 

ESHRE NEWS – The European Society of Human Reproduction and Embryology in their January 2009 publication gave an update on their project involving the status of donor anonymity and embryo research.  The picture emerging so far is mixed, from countries such as Belgium, Italy, Norway, Denmark, France, Germany, Greece, Protugal, Russia, Spain and the UK, though most countries favor anonymous sperm donation.  The exceptions are Germany (where egg donation is not allowed, but sperm donation is), Norway and UK, which all give children conceived by donor sperm the right at the age of 18 to know the donor’s identity.  Women in Russia and so far Belgium can be treated by known and anonymous sperm donation. No gamete donation is allowed in Italy.  More details can be found on the ESHRE website at www.eshre.com.

 

 

Theresa M. Erickson, Esq.
Surrogacy Lawyer & Egg Donation Lawyer 
www.EricksonLaw.net

Subscribe to my blog at: http://www.surrogacyeggdonorblog.com/subscribe.html

 
 

 

FRIDAY LEGAL UPATES - Octuplets, Missouri Donor Legislation & Indian Surrogacy

 

A. Missouri – it appears that the Missouri legislature, headed by Cynthia Davis. In her bill (HB355) she is attempting to ban all anonymous donation (egg and sperm) in Missouri and give all donor-conceived offspring the right to access the donor’s identity at age 21.          In fact, she wants the child’s birth certificate reflect the biological parent’s name (yes, she called the donor a parent) and the donor parent’s name as well. She is not intending to create any legal relationship between donors and the offspring, but the use of the word PARENT is extremely disturbing. What do you think?

 

 

Click Here for the information on this bill HB355

Blog On Bill HB355

B. Octuplet Case – the ASRM is now considering to kick the octuplet doctor out of the society. What affect do you think this will really have? And, with his new case of quadruplets, why do patients keep seeking him out for treatment, especially with his (un)success rates?

Click Here for an Article on this Case in WSJ

Click Here for an Article on this Case in Union Tribune

Click Here for an Article on this Case in New York Post

C. India Surrogacy & a Legal Warning – I read an informative article on a warning to couples/individuals going to India for a surrogate mother. The article discusses what I have guessed all along, that pursuing surrogacy in India is still a risky process because there are still no comprehensive laws covering the practice. I am always concerned when people cut corners when they are in such a vulnerable and desperate state of mind. What do you think?

See article at www.theage.com.au

Theresa M. Erickson, Esq. www.ericksonlaw.net

 

 

 

 

 

Octuplets and Regulation - What Should We Do with Fertility Treatments?

I am still waiting for this controversy to finally die down, but it sure does not look that way with new information coming out about the mother and her fertility doctor.  But, today I want to stay away from that and look more to the regulations that everyone is literally screaming for at the top of their lungs.  I understand that everyone wants some control since it looks like the tax payers are ultimately going to pay the bill for her decisions, but I also want to make note of how regulations will also affect the millions of other fertility patients that do make sound decisions in their family planning.

First, in other countries that have regulations surrounding the number of embryos being implanted, I want to note that the government actually foots the bill for a certain number of IVF cycles - thereby giving patients an added assurance that they can try one embryo at a time because their government will pay for another (possibly) cycle.  Here, in the US, we do not have that luxury as this is a cash business.  Very few, if any states and insurance companies cover the costs of IVF.  These patients are then placed in the dilemma of not having enough funds to cover another cycle if this one does not work.

Now, with that in mind, I want to encourage everyone to look at the issue of regulations with an open mind, and look at what Dr. James A. Grifo, the program director of the New York University Fertility Center at the Langone Medical Center and a professor of obstetrics and gynecology at the university’s School of Medicine, has to say in the following piece:

"The fascination with the octuplets born last week has dominated the news media. But after the initial marvel of the miraculous feat faded, we were left wondering why an unemployed mother of six wanted more. Responses from around the country, and within the medical community, included cries of malpractice and demands for new laws regulating fertility treatment.

But where would this lead? A knee-jerk response to one outlier does not always prevent the next. Legislation about how to practice medicine threatens doctor-patient relations and has unintended consequences that may be worse than the actual problem. We live in a country that doesn’t regulate family size. If we were to decree a proper number, who would decide?

In 1992, Congress passed a law requiring fertility clinics to report their pregnancy rates. It came about because a rogue practitioner was telling patients the success rates of in vitro fertilization based on national statistics and neglecting to mention that his own clinic had none. Thus a national registry was born, financed by taxpayers. The clinics that refused were listed as non reporters, hardly a punishment.

But the implications of a government published report were unanticipated and it changed behavior. Since clinics were measured by pregnancy rates, there was incentive to implant more embryos into a patient — creating the unwanted consequence of a boom in twins and triplets.

The American Society of Reproductive Medicine and its subgroup, the Society for Assisted Reproductive Technologists, recognized the problem and published guidelines for the number of embryos to transfer to maximize pregnancy rates but minimize multiple gestation, especially triplets and beyond. We have now published three iterations of these guidelines since 1999 with a significant decline in the incidence of triplets and higher. This happened without laws being passed; it was simple cooperation of clinicians doing the right thing for positive change to happen.

Medicine cannot be practiced in a vacuum or by legislation. It requires a patient and physician dialogue, it requires decision-making that minimizes risk and maximizes good outcome, and it requires patients and physicians to make good decisions. Indeed, that is already happening but that story is lost in the tsunami of one unusual case whose facts are not known."

Click Here for the Complete Article

Theresa M. Erickson, Esq.
Surrogacy Lawyer & Egg Donation Lawyer 
www.EricksonLaw.net

Subscribe to my blog at: http://www.surrogacyeggdonorblog.com/subscribe.html

Octuplets Birth Continues to Cause "Outrage" - What Do You Think?

I do hate stories such as this that capture so much media attention.  They actually take away attention from all of the "good" stories out there, such as the couple who conquered their infertility after five tries at IVF.  Just today I read scores of articles calling the birth an outrage and the actions of the doctor criminal.  I am still on the fence about this entire story, and I am withholding judgment at this point, but I am curious to see what others are thinking.

Click Here for Article from LA Times - Octuplets' birth spawns outrage

Click Here for a Press Release from an IVF Physician in Georgia

Click Here for Blog from San Diego IVF Physician

Theresa M. Erickson, Esq.
Surrogacy Lawyer & Egg Donation Lawyer 
www.EricksonLaw.net

Subscribe to my blog at: http://www.surrogacyeggdonorblog.com/subscribe.html

The Octuplets and Regulations - What Should We Do?

I have been trying to show restraint with my opinion on the octuplets because I believe strongly in reproductive freedom for everyone in America, and I also understand an individuals strong desire for children.  But, I really enjoyed the piece written by George Dvorsky on the Institute for Ethics and Emerging Technologies Blog.  He makes quite a few good points involving common sense and restraint.  As many have cited, he wants ASRM to set up and give their guidelines some teeth.  I am not certain if that will happen or if it should happen, but let me know what you think. 

"Like a lot of people last week, I was shocked to find out that Nadya Suleman, the mother of the octuplets born last week in Los Angeles, already has 6 children—all between the ages of 2 and 7.

And that she is a single mother who has already filed for bankruptcy, and that she is a self-described “professional student” who lives off education grants and parental money.....

Looking at this case one gets the feeling that some fertility clinics look upon their patients as nothing more than customers. Given the nature of their work, however, this attitude will simply not do.

A lassez-faire approach to repro-tech won’t work to protect the interests of those hoping to use these technologies and to protect those lives that are created as a result. I agree that regulation should be very liberal and accommodating to a diverse set of interests, but complete de-regulation would be both dangerous and facile.

But establishing regulations and guidelines is one thing, enforcing it is quite another.

In some cases, this one included, it would be perfectly reasonable for the state to intervene and deny access, or at the very least compel clinics to follow a strict set of guidelines to prevent this sort of thing from happening. It’s time to empower groups like the ASRM—particularly now as new reproductive technologies are emerging quickly. This way, fertility clinics will be compelled to follow the rules and be held accountable for their actions.

It’s clear that this has to happen. Clinics won’t regulate themselves.

But why should we have expected them to? They’re not the ones who now have to raise these children. "

Click Here For Complete Article

See Also Article by the Reproductive Rights Prof Blog

Theresa M. Erickson, Esq.
Surrogacy Lawyer & Egg Donation Lawyer 
www.EricksonLaw.net

Subscribe to my blog at: http://www.surrogacyeggdonorblog.com/subscribe.html


 

Friday Legal Updates - Embryo Dispute, Donor Conceived Children & Those Octuplets

Well, we have quite a day in legal news today. So, let’s start with the notorious octuplets –

As Sarah Palin, whether you like her or not, would say “Joe, say it isn’t so” to this one. This week I reported that this mother of eight should not be judged until “we have walked in her shoes,” but today all of the news outlets (such as LA Times, GMA, Today, etc.) are reporting that she already has six kids and reproductive technologies were used, whether IVF, Clomid, or some other means. 

Karen Hammond of the AFA stated “I congratulate this lady for having the fortitude to carry octuplets to viability, but in a sense, this birth represents a failure of infertility treatment. The majority of such high-order multiple pregnancies end with loss of all the infants, and multiple pregnancy poses dangers for the mother as well,” says Hammond.

Even Fox News made a great argument stating that the focus should not be on why she did not selective reduce, but why, if the story is true, did her physician place eight, yes 8, embryos into her uterus. I certainly hope that it was not an American physician – what will the ASRM say or do about this? Either way, I am concerned about regulation due to the actions of a few if embryos were transferred.

I think that the jury is out on this one until we get all of the facts, but here is the update. Let’s see how it turns out. What do you think? 

Now, as for the donor conceived case filed in Canada, the court has ruled as follows:

“For the first time in Canada a court has ruled on the legitimacy of a donor contract in determining the competing parental rights of a lesbian couple and a gay man who was the sperm donor.

The precedent-setting court ruling that the agreement is not enforceable could open the door for a child to have three or four recognized parents in "known donor" situations.”

At the same time, it may also have a chilling effect on lesbian couples seeking a specific donor and who want their child to know the identity of the father.

The legal dispute involves a lesbian couple in Toronto and a gay man who agreed to be their sperm donor and play an active role as a parent.

Click Here for the Complete Article

And, finally, we have a woman who has died leaving three frozen embryos. It is stated that her fiancé, who sperm was used, wants to use his sister as a carrier.   The dead woman’s mother is poised to fight that this is not her daughter’s wishes. We will see where this one goes. 

Click Here for the Complete Article

Theresa M. Erickson, Esq.
Surrogacy Lawyer & Egg Donation Lawyer 
www.EricksonLaw.net

Subscribe to my blog at: http://www.surrogacyeggdonorblog.com/subscribe.html